Radiofrequency ablation of ventricular premature contraction originating from a native coronary cusp after transcatheter aortic valve replacement

Abstract

We describe a case of radiofrequency ablation of ventricular premature contraction (VPC) originating from the left ventricular outflow tract after transcatheter aortic valve replacement. The VPC origin was the native aortic valve annulus between the left and right coronary cusps. Radiofrequency ablation was successfully performed by manipulating the ablation catheter from the gap between the sinotubular junction and implanted valve.

Special considerations in mapping and ablation of focal ventricular arrhythmias originating from the left ventricular outflow tract in patients with a transcatheter aortic valve replacement

“…The aorto‐mitral continuity (AMC) that is located just underneath the left aortic cusp is also one of the major sites of idiopathic focal VA origins . An early onset of focal VAs after the TAVR has been reported, suggesting iatrogenic causes such as inflammation, ischemia, and muscle stretch …”

“…Transcatheter aortic valve replacements (TAVRs) are a minimally invasive procedure and have been increasingly performed in high‐risk patients with severe aortic stenosis that are not candidates for open‐heart surgery . Focal LVOT VAs also can occur after a TAVR, and RFCA should be considered as a treatment option when those VAs are drug‐refractory . However, there should be specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT.…”

“…3 Focal LVOT VAs also can occur after a TAVR, and RFCA should be considered as a treatment option when those VAs are drug-refractory. [4][5][6] However, there should be specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT. This article describes those challenges and practical approach of mapping and ablation of LVOT VAs in patients with a TAVR.…”

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

“…It might be due to an impairment of the conduction system during surgery and, therefore, emerges as the most common type of VT in the early postoperative period. In addition, the postulated precipitating factors for ventricular arrhythmogenesis include invading calcification from the degenerated valve to the conduction system, mechanical irritation to the myocardium by the prosthetic valve, ischemia, heightened adrenergic state of the postoperative period, and surgical scar (2,13,(16)(17)(18)(19)(20).…”